This study aimed to investigate the features of later stage BD and specifically, factors underlying later stage BD and potential subgroups within this stage, to understand more about the later stage group and contribute to the measurement of stage.

OBJECTIVES Diagnosis and management of bipolar disorder (BD) are limited by the absence of available biomarkers. Allostatic load (AL) represents the strain that stress, including the effects of acute phases and inter-episode chronic mood instability, exerts on interconnected biological systems. This study aimed to operationalize an AL index and explore whether it could be relevant to better characterize

OBJECTIVE To determine the effectiveness of intravenous (IV) ketamine on anxiety, irritability, agitation, and suicidality, in adults with treatment-resistant major depressive disorder (MDD) or bipolar disorder (BD). METHOD Adults (N = 201) with treatment-resistant MDD or BD received repeat-dose IV ketamine treatment at a community-based clinic. Mixed features were measured using symptoms of anxiety

OBJECTIVE To examine temporal patterns and predictors for diagnostic conversion from unipolar depression (UD) to bipolar disorder (BD), schizophrenia, and schizoaffective disorder (SAD). METHODS A prospective nationwide register-based cohort (n = 43 495) of all first psychiatric hospitalizations due to UD during 1996-2011 was followed up to 15 years. We used cumulative incidence function (CIF) analyses

OBJECTIVES Childhood maltreatment has been associated to an increased risk of developing bipolar disorder (BD). A role of the hypothalamus-pituitary-adrenal (HPA) axis in mediating trauma-related risk for adult psychopathology has been suggested but scarcely investigated in BD. Therefore, we explored the impact of childhood maltreatment on clinical features of BD and on the activity of the HPA axis

The diagnostic and therapeutic controversies over mixed mood states have many causes. The general problem of validity of mental disorders, the unsteady character of psychiatric symptoms, the changing diagnostic criteria and the dearth of randomized studies, especiallydesigned for the subpopulation of bipolar patients with mixed features are several reasons whichimpedethe diagnostic and treatment decisions

Transcranial direct current stimulation (tDCS) recently appeared as a novel treatment that could be a potential therapeutic option for patients with bipolar depression. tDCS is an experimental treatment and should not be considered as a treatment that can replace medications or electroconvulsive therapy in bipolar depression tDCS could be a potential effective alternative in specific neuropsychiatric

Delirious Mania (DM) is a severe and under-recognized neuropsychiatric syndrome characterized by a rapid onset of delirium, mania and psychosis. Despite being a well-described clinical entity, it is frequently unrecognized and misdiagnosed as acute episodes of organic delirium, which is dangerous because it can progress rapidly and be lethal.

OBJECTIVES The association of bipolar disorder with early and excessive cardiovascular disease was identified over a century ago. Nonetheless, the vascular-bipolar link remains under-recognized, particularly with regard to how this link can contribute to our understanding of pathogenesis and treatment. METHODS An international group of experts completed a selective review of the literature, distilling

We recently published a debate article on the topic of cognitive interventions for mood disorders (1), which has received interest from experts in the area, including many of our respected colleagues (2, 3). We appreciate, as Burdick et al. (2) point out, that novel and important research is being conducted worldwide to address the issue of persisting cognitive impairment in mood disorders. It is therefore

Linke and collaborators published in Bipolar Disorders (December 2019) the results of a whole-brain Diffusion Tensor Imaging (DTI) study that measured fractional anisotropy (FA) (as a marker of white matter structure abnormalities) in youths with BD, non-BD first-degree relatives of individuals with BD (i.e. "at risk" individuals) and healthy controls (HC) (1). The authors reported a significant decrease

"A nosological nuisance, but a clinical reality", that is how psychiatrists Andreas Marneros and Hagop Akiskal once described schizoaffective disorder (SAD), aptly expressing a widely held view in the field and arguing for the necessity of the diagnosis. On the other hand, critics have emphasized weaknesses in the conception of schizoaffective disorder. Gin S. Malhi, to name only one of the most outspoken

Mental disorders are ranked among the most substantial causes of disability worldwide. Moreover, they are increasingly being recognized as complex diagnostic entities with largely unknown etiological backgrounds. Apart from genetic risk factors, several environmental exposures, including pregnancy and perinatal risk factors, psychosocial stressors, urbanicity, poverty and substance use, have been associated

OBJECTIVE Bipolar disorder (BD) has been associated with abnormal reward functioning including pleasure-seeking and impulsivity. Here we sought to clarify whether these changes can be attributed to abnormalities in the neural processing of reward valuation or error prediction. Moreover, we tested whether abnormalities in these processes are associated with familial vulnerability to BD. METHODS We obtained

Over the past few decades, lithium carbonate has been used as an effective therapeutic agent for the treatment of bipolar affective disorders. Lithium is an extremely potent mood stabilizer andprovides protection against both manic and depressive episodes. Lithium also plays a substantial role in reducing suicidal deaths among bipolar patients.

OBJECTIVE To reanalyze Aristotle's classic lecture, "On melancholy," with current clinical interpretations. METHOD The full lecture is described and interpreted in a new translation. RESULTS Aristotle's lecture has been understood to reflect a claim about a link between genius and madness, or more specifically depression and genius. In fact, his concept of melancholia included what today would be called

OBJECTIVES Systematically review the prevalence of functional impairment (FI) in euthymic patients with bipolar disorder (BD), as assessed only with the Functioning Assessment Short Test (FAST), explore the prevalence of this impairment among all the domains, identify the most compromised of them and the clinical variables associated with low functioning in this population. METHODS Meta-analyses were

OBJECTIVES Recent studies have suggested that evening blue light exposure is associated with sleep and circadian rhythm abnormalities. This study examined the effect of blue-blocking (BB) glasses on sleep and circadian rhythm in patients with bipolar disorder (BD). METHODS We used a randomized, placebo-controlled, double-blinded design. Outpatients with BD and also with insomnia were randomly assigned

Bipolar disorder (BD) is a psychiatric condition causing shifts in mood, energy and activity levels severely altering the quality of life of the patients even in the euthymic phase. Although widely accepted, the neurobiological bases of the disorder in the euthymic phase remain elusive. This study aims at characterizing resting state functional activity of the BD euthymic phase in order to better understand

Sleep problems are common in bipolar disorders (BDs). To objectively characterize these problems in BDs, further methodological development is needed to capture subjective insomnia.

Loss‐of‐function mutations in the gene encoding the calcium‐calmodulin (Ca2+‐CaM)‐dependent protein kinase kinase‐2 (CaMKK2) enzyme are linked to bipolar disorder. Recently, a de novo arginine to cysteine (R311C) mutation in CaMKK2 was identified from a whole exome sequencing study of bipolar patients and their unaffected parents. The aim of the present study was to determine the functional consequences

The Korean Medication Algorithm Project for Bipolar Disorder (KMAP‐BP) is based on expert consensus and has been revised five times since 2002. This study evaluated the changes in treatment strategies advocated by the KMAP‐BP over time.

OBJECTIVES The existence of anatomo-functional brain abnormalities in Bipolar Disorder (BD) is now well established by magnetic resonance imaging (MRI) studies. To create diagnostic and prognostic tools, as well as identifying biologically valid subtypes of BD, research has recently turned towards the use of machine learning (ML) techniques. We assessed both supervised ML and unsupervised ML studies

OBJECTIVE Most patients with bipolar disorders (BD) exhibit prodromal symptoms before a first (hypo)manic episode. Patients with clinically significant symptoms fulfilling at-risk criteria for serious mental illness (SMI) require effective and safe treatment. Cognitive-behavioral psychotherapy (CBT) has shown promising results in early stages of BD and in patients at high-risk for psychosis. We aimed

Bipolar disorder (BD) is a common mental disorder, with approximately 2.4% lifetime prevalence in the general population. In addition, the co‐occurrence of other psychiatric disorders with BD is very high, with as many as 65% to 95% meeting the diagnostic criteria for comorbid conditions(1). Of these, about 25% are comorbid with obsessive‐compulsive disorder (OCD), and 10.6% with gambling disorder

Lithium is the gold standard treatment for bipolar disorders yet remains underutilized. Concerns among both patients and prescribing clinicians about Lithium’s narrow therapeutic index and potential for toxicity, necessitating blood level monitoring, is well documented. So too are serious long‐term side effects, for which psychiatrists must be ever vigilant and adequately trained to both prevent and

Manic-depressive illness has too often been outshined by Bipolar Disorders (BD). Young psychiatrists risk forgetting the tight link between mania and depression and regard the two poles of illness as separate entities. This approach is unsupported by historical and psychopathological standpoints. Malhi's and colleagues recently proposed ACE (Activity, Cognition and Emotion) model, which is based on

The article “The Unique Utility of Digital Technology for Bipolar Disorder”, by Dr. Sarah Goodday (Bipolar Disord 2019 Nov 1, Epub ahead of print)1 raises important points related to the limitations associated with the current nosological status of bipolar disorder (BD), emphasizing the potential role of digital technological innovations (e.g., smartphones) in the monitoring of different cognitive

Oral ziprasidone (ziprasidone hydrochloride) has been approved by the U.S. Food and Drug Administration (FDA) in 2001 for the treatment of schizophrenia, and acute manic or mixed episodes associated with bipolar disorder (BPD) with or without psychotic features. Ziprasidone intramuscular (ziprasidone mesylate) is FDA‐approved for acute agitation in patients with schizophrenia.

OBJECTIVES Despite previous literature on comorbid alcohol use disorders (AUDs) in bipolar disorder (BD), little is known about patterns of alcohol use more widely in this population. We have examined lifetime heaviest average weekly alcohol consumption levels in a large well-characterised UK sample including lifetime clinical correlates of increasing levels of alcohol use. METHODS Participants were

Depression research historically uses both self‐ and clinician ratings of symptoms with significant and substantial correlations. It is often assumed that manic patients lack insight and cannot accurately report their symptoms. This delayed the development of self‐rating scales for mania, but several scales now exist and are used in research. Our objective is to systematically review the literature

Lithium is the gold‐standard treatment for bipolar disorder (BD). Long‐term lithium use can increase the risk of chronic kidney disease (CKD). However, lithium can be safely used in patients with CKD while minimizing polypharmacy and may not necessarily increase the risk of developing end‐stage renal disease (ESRD), thus maintaining mood stability. We present a case of an excellent lithium responder

The recent systematic review and meta‐analysis by Szmulewicz, Valerio (1) addresses an issue of current debate in the field ‐ that of whether cognition in bipolar disorder (BD) is neuroprogressive or stable(2). Based on a synthesis of studies of longitudinal cognitive performance in recent‐onset (8 studies) and late‐life BD (4 studies), this review provides evidence against this hypothesis and is consistent

Although not listed in the DSM‐5, musical obsessions (also known as stuck song syndrome) are generally considered a symptom of obsessive‐compulsive disorder. Occurring alone or concurrently with other symptoms of obsessive‐compulsive disorder, musical obsessions may be common in bipolar disorder. Due to the lack of awareness and availability of proper screening measures, under‐diagnosis of musical

If anyone dies - the question is when and what the cause is, and how the quality of life has been. Patients with bipolar disorder and patients with schizophrenia, most often comprising the group of patients defined as severe mental illness (SMI), have an increased mortality rate in comparison to the general population (1,2). Despite differences between disorders there are similar patterns of increasing

Misinformed, misconducted, misguided and misrepresented meta-analyses. The use of antidepressants (AD) in major depressive disorders (MDD). The often mud-throwing long-standing debate on the use of antidepressant was rebooted by a meta-analyses from a Danish group in 2017. In that paper, the authors successfully distorted the overall primary outcome (that selective serotonin reuptake inhibitors (SSRI)

The article "Lithium and Woozle effect" by Kelly T1 discusses the reasons for discrepancies between the guidelines recommending for and against lithium. They have reported that woozle effect, reference inflation, belief perseverance were present in the guidelines recommending lithium. In this context, it might be imperative to critically overview guidelines recommending against lithium such as Texas

Seasonal peaks in hospitalizations for mood disorders and schizophrenia are well recognized and often replicated. The within‐subject tendency to experience illness episodes in the same season, that is, seasonal course, is much less established, as certain individuals may temporarily meet criteria for seasonal course purely by chance.

Bipolar disorder (BD) and familial risk for BD have been associated with aberrant white matter (WM) microstructure in the corpus callosum and fronto‐limbic pathways. These abnormalities might constitute trait or state marker and have been suggested to result from aberrant maturation and to relate to difficulties in emotion regulation.

OBJECTIVE The aim of this study was to evaluate the efficacy and safety of the dopaminergic-enhancing agent modafinil/armodafinil (MoArm) as adjunctive treatment for bipolar depression. METHODS A comprehensive search of major electronic databases was conducted to identify randomized controlled trials (RCTs) of adjunctive MoArm that included patients with bipolar I (BP-I) or bipolar II (BP-II) depression

OBJECTIVES To focus on a specific group of patients whose diagnoses were changed from unipolar depression to bipolar disorder, and finally to dementia. METHODS Qualitative review of the relevant articles. RESULTS A substantial portion of patients with unipolar depression manifest manic and/or hypomanic episodes, resulting in a change of diagnoses to bipolar disorder. Further, a substantial portion

OBJECTIVES To compare the longitudinal clinical course of youths with bipolar disorder (BD) spectrum with lifetime (past, intake, and/or follow-up) psychosis (BDP+) to youths with BD without lifetime psychosis (BDP-). Also, to identify risk factors associated with increased risk of first onset of psychosis during prospective follow-up. METHOD Bipolar disorder youths (BDP+ = 137, BDP- = 233), aged 7-17

OBJECTIVES Higher rates of thyroid conditions are reported in individuals with bipolar disorder. However, no study to date has considered whether maternal thyroid conditions during pregnancy are associated with offspring risk of bipolar disorder, even though the fetus exclusively relies on maternal thyroid hormones through the early second trimester. We therefore examined the association between offspring

OBJECTIVES Network analyses of psychopathology examine the relationships between individual symptoms in an attempt to establish the causal interactions between symptoms that may give rise to episodes of psychiatric disorders. We conducted a network analysis of mood symptoms in adolescents with or at risk for bipolar spectrum disorders. METHODS The sample consisted of 272 treatment-seeking adolescents

OBJECTIVES Evidence suggests accelerated aging mechanisms in bipolar disorder (BD), including DNA methylation (DNAm) aging in blood. However, it is unknown whether such mechanisms are also evident in the brain, in particular in association with other biological clocks. To investigate this, we interrogated genome-wide DNAm in postmortem hippocampus from 32 BD-I patients and 32 non-psychiatric controls

BACKGROUND Proton longitudinal relaxation (T1 ) is a quantitative MRI-derived tissue parameter sensitive to myelin, macromolecular, iron and water content. There is some evidence to suggest that cortical T1 is elevated in bipolar disorder and that lithium administration reduces cortical T1 . However, T1 has not yet been quantified in separate groups containing lithium-treated patients, lithium-naïve

OBJECTIVES In clinical practice, bipolar depression (BD) and unipolar depression (UD) appear to have similar symptoms, causing BD being frequently misdiagnosed as UD, leading to improper treatment decision and outcome. Therefore, it is in urgent need of distinguishing BD from UD based on clinical objective biomarkers as early as possible. Here, we aimed to integrate brain neuroimaging data and an advanced

OBJECTIVES Smooth pursuit eye movement deficits are an established psychosis biomarker across schizophrenia, schizoaffective and psychotic bipolar disorder (BPwP). Whether smooth pursuit deficits are also seen in bipolar disorder without psychosis (BPwoP) is unclear. Here we present data from the Psychosis and Affective Research Domains and Intermediate Phenotypes (PARDIP) study comparing bipolar patients

OBJECTIVES Current research suggests significant disruptions in functional brain networks in individuals with mood disorder, and in those at familial risk. Studies of structural brain networks provide important insights into synchronized maturational change but have received less attention. We aimed to investigate developmental relationships of large-scale brain networks in mood disorder using structural

OBJECTIVES Large-scale studies on phenotypic differences between bipolar disorder type I (BDI) and type II (BDII) are scarce. METHODS Individuals with BDI (N = 4806) and BDII (N = 3960) were compared with respect to clinical features, illness course, comorbid conditions, suicidality, and socioeconomic factors using data from the Swedish national quality assurance register for bipolar disorders (BipoläR)

OBJECTIVES Cariprazine is a partial agonist at D2/D3 receptors that has been approved for the treatment of mania associated with bipolar disorder (BD). This meta-analysis aimed to assess the efficacy and tolerability of cariprazine in the treatment of BD. METHODS Randomized controlled trials investigating the efficacy of cariprazine in BD were included. Of the 391 studies yielded by search, 7 were

OBJECTIVES The suicide crisis is a relatively short-lived psychiatric emergency, with transient symptoms that ebb and flow around the suicide attempt. Understanding the dynamic processes of symptoms before and after suicide attempt may aid future prevention efforts. METHODS Data were drawn from the NIMH STEP-BD study, which followed 4,360 patients with bipolar disorder; a subset attempted suicide during

OBJECTIVES Number of mood episodes (NoE) may be an important prognostic indicator in bipolar disorder, with implications for treatment. However, NoE has been conceptualized and measured inconsistently throughout the literature. This review examines the construct of NoE in bipolar disorder, with the aim of enhancing its conceptualization and measurement. METHODS A critical evaluation of literatures

BACKGROUND Childhood maltreatment is a well-known risk factor for developing a more severe and complex form of bipolar disorders (BD). However, knowledge is scarce about the interactions between childhood maltreatment and underlying genetic vulnerability on the clinical expression of BD. METHOD We assigned a BD-polygenic risk score (BD-PRS), calculated from the Psychiatric Genomics Consortium, to each

BACKGROUND The Psychopharmacology Algorithm Project at the Harvard South Shore Program (PAPHSS) published algorithms for bipolar depression in 1999 and 2010. Developments over the past 9 years suggest that another update is needed. METHODS The 2010 algorithm and associated references were reevaluated. A literature search was conducted on PubMed for recent studies and review articles to see what changes